超声联合血清学指标预测丙氨酸转氨酶正常或轻度升高的慢性乙型肝炎患者非酒精性脂肪性肝病的临床意义

Clinical significance of ultrasound combined with serological indexes for predicting nonalcoholic fatty liver disease in patients with chronic hepatitis B with normal or slightly elevated alanine aminotransferase

目的探讨丙氨酸转氨酶(ALT)正常或轻度升高的慢性乙型肝炎患者合并非酒精性脂肪性肝病的相关因素,以建立无创评分模型进行预测。方法共纳入128例已接受肝活检术的慢性乙型肝炎患者,根据肝活检病理结果是否存在肝细胞脂肪变性将其分为有脂肪浸润组和无脂肪浸润组。收集患者人口学特征、实验室检验指标以及病理学检测结果。通过单因素及多因素logistic回归分析结合临床筛选变量并建立预测模型。应用受试者操作曲线评价新模型预测效能,并通过Delong法比较新模型与超声检查对于诊断脂肪肝准确性的差异。结果多因素回归分析显示,血清甘油三酯、血尿酸及血小板与肝内脂肪变性高度相关(P<0.05)。结合上述变量建立回归方程triglyceride-uric acid-platelet(TUP)-1=-8.195+0.011×尿酸+1.439×甘油三酯+0.012×血小板计数。纳入腹部超声结果后,建立方程TUP-2=-7.527+0.010×尿酸+1.309×甘油三酯+0.012×血小板计数+1.397×脂肪肝(超声检查)(有=1;无=0)。TUP-1与TUP-2模型对脂肪肝的诊断价值均优于单独超声检查。TUP-1与TUP-2模型间诊断价值差异无统计学意义(Z=1.453,P=0.146)。结论新模型相较于单独的腹部超声检查,在诊断脂肪肝方面诊断效力更强,具有良好的应用价值。

Objective To investigate and establish the related factors of non-invasive score model for prediction of non-alcoholic fatty liver disease in chronic hepatitis B patients with normal or mildly elevated alanine aminotransferase(ALT).Methods A total of 128 cases with chronic hepatitis B who had undergone liver biopsy were included.According to the presence or absence of hepatocyte steatosis on the pathological results of liver biopsy,they were divided into a fatty infiltration and a non-fatty infiltration group.Patients'demographic characteristics,laboratory test indexes,and pathological test results were collected.Univariate and multivariate logistic regression analysis combined with clinical screening variables were used to establish a predictive model.The prediction efficiency of the new model was evaluated by the receiver operating curve,and the difference between the accuracy of the new model and ultrasound in the diagnosis of fatty liver was compared by Delong's-test.Result Multivariate regression analysis showed that serum triglyceride,serum uric acid and platelets were highly correlated with intrahepatic steatosis(P<0.05).The regression equation triglyceride-uric acid-platelet(TUP)-1=-8.195+0.011×uric acid+1.439×triglyceride+0.012×platelet count was established by combining the above variables.Tthe equation TUP-2=-7.527+0.010×uric acid+1.309×triglyceride+0.012×platelet count+1.397×fatty liver(ultrasound)was established(yes=1;no=0)after incorporating the results of abdominal ultrasound.The diagnostic value of TUP-1 and TUP-2 models for fatty liver was better than that of ultrasound alone and there was no statistically significant difference in diagnostic value between TUP-1 and TUP-2 models(Z=1.453,P=0.146).Conclusion Compared with abdominal ultrasonography alone,the new model is more effective in diagnosing fatty liver and has good application value.